Prevention, Reduction and Repair of Brain Injury of the Preterm Infant.

Frank Van Bel,Josine Vaes,Floris Groenendaal

doi:10.3389/fphys.2019.00181

Abstract

Periventricular-intraventricular hemorrhages (PIVH) and (diffuse) white matter injury (WMI) are the most important acquired brain lesions of the very and extremely prematurely born neonate. Both carry a high risk for death or adverse neurodevelopmental outcome. The first part of the review discusses the standard of care and latest insights with respect to prevention and/or reduction of PIVH and WMI, taking into account their etiopathogenesis which is tightly linked to (functional) immaturity of the cerebral vascular bed and nervous system and commonly encountered inflammation. The second part discusses repair of hemorrhagic- ischemic and post-inflammatory brain lesions as it is an increasingly important topic in newborn medicine. In the near future trials of trophic and (autologous or allogenic) cell-therapy in infants at risk of or demonstrating established PIVH and WMI will be started. The focus of these potential trials will be discussed.

Highlights

The most important acquired brain injuries in very and extremely preterm infants born in developed countries are periventricular-intraventricular hemorrhages (PIVH) and diffuse white matter injury
The second aim is to focus on repair of the sequelae of PIVH and diffuse white matter injury (dWMI)
There is increasing evidence that repair of perinatal brain injury with trophic and/or stem cell therapy is currently becoming a realistic and exciting option (Fleiss et al, 2014; Fischer et al, 2017; Wagenaar et al, 2017). We discuss this development in relation with repair of the sequelae of severe PIVH and dWMI

Summary

INTRODUCTION

The most important acquired brain injuries in very and extremely preterm infants born in developed countries are periventricular-intraventricular hemorrhages (PIVH) and diffuse white matter injury (dWMI, Figure 1; Stoll et al, 2010; Hamilton et al, 2013; Pierrat et al, 2017). There is increasing evidence that repair of perinatal brain injury with trophic and/or stem cell therapy is currently becoming a realistic and exciting option (Fleiss et al, 2014; Fischer et al, 2017; Wagenaar et al, 2017) We discuss this development in relation with repair of the sequelae of severe PIVH and dWMI. Frontiers in Physiology | www.frontiersin.org van Bel et al

Reduction and Repair of Preterm Brain Injury

Standard care

WHITE MATTER INJURY IN THE VERY AND EXTREMELY PRETERM INFANT

Findings

REPAIR OF SEQUELAE OF PIVH AND dWMI